Universidad Peruana Cayetano Heredia

Universal definition of loss to follow-up in HIV treatment programs: A statistical analysis of 111 facilities in Africa, Asia, and Latin America

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dc.contributor.author Chi, B.H.
dc.contributor.author Yiannoutsos, C.T.
dc.contributor.author Westfall, A.O.
dc.contributor.author Newman, J.E.
dc.contributor.author Zhou, J.
dc.contributor.author Cesar, C.
dc.contributor.author Brinkhof, M.W.G.
dc.contributor.author Mwango, A.
dc.contributor.author Balestre, E.
dc.contributor.author Carriquiry, G.
dc.contributor.author Sirisanthana, T.
dc.contributor.author Mukumbi, H.
dc.contributor.author Martin, J.N.
dc.contributor.author Grimsrud, A.
dc.contributor.author Bacon, M.
dc.contributor.author Thiebaut, R.
dc.date.accessioned 2022-01-18T19:34:37Z
dc.date.available 2022-01-18T19:34:37Z
dc.date.issued 2011
dc.identifier.uri https://hdl.handle.net/20.500.12866/11060
dc.description.abstract Background: Although patient attrition is recognized as a threat to the long-term success of antiretroviral therapy programs worldwide, there is no universal definition for classifying patients as lost to follow-up (LTFU). We analyzed data from health facilities across Africa, Asia, and Latin America to empirically determine a standard LTFU definition. Methods and Findings: At a set "status classification" date, patients were categorized as either "active" or "LTFU" according to different intervals from time of last clinic encounter. For each threshold, we looked forward 365 d to assess the performance and accuracy of this initial classification. The best-performing definition for LTFU had the lowest proportion of patients misclassified as active or LTFU. Observational data from 111 health facilities-representing 180,718 patients from 19 countries-were included in this study. In the primary analysis, for which data from all facilities were pooled, an interval of 180 d (95% confidence interval [CI]: 173-181 d) since last patient encounter resulted in the fewest misclassifications (7.7%, 95% CI: 7.6%-7.8%). A secondary analysis that gave equal weight to cohorts and to regions generated a similar result (175 d); however, an alternate approach that used inverse weighting for cohorts based on variance and equal weighting for regions produced a slightly lower summary measure (150 d). When examined at the facility level, the best-performing definition varied from 58 to 383 d (mean = 150 d), but when a standard definition of 180 d was applied to each facility, only slight increases in misclassification (mean = 1.2%, 95% CI: 1.0%-1.5%) were observed. Using this definition, the proportion of patients classified as LTFU by facility ranged from 3.1% to 45.1% (mean = 19.9%, 95% CI: 19.1%-21.7%). Conclusions: Based on this evaluation, we recommend the adoption of ≥180 d since the last clinic visit as a standard LTFU definition. Such standardization is an important step to understanding the reasons that underlie patient attrition and establishing more reliable and comparable program evaluation worldwide. en_US
dc.language.iso eng
dc.publisher Public Library of Science
dc.relation.ispartofseries PLoS Medicine
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Humans en_US
dc.subject cohort analysis en_US
dc.subject Cohort Studies en_US
dc.subject controlled study en_US
dc.subject rural area en_US
dc.subject Delivery of Health Care en_US
dc.subject Latin America en_US
dc.subject South and Central America en_US
dc.subject HIV Infections en_US
dc.subject Human immunodeficiency virus infection en_US
dc.subject statistics en_US
dc.subject HIV en_US
dc.subject Follow-Up Studies en_US
dc.subject standardization en_US
dc.subject highly active antiretroviral therapy en_US
dc.subject urban area en_US
dc.subject health care delivery en_US
dc.subject Antiretroviral Therapy, Highly Active en_US
dc.subject Patient Compliance en_US
dc.subject health center en_US
dc.subject Africa en_US
dc.subject health care en_US
dc.subject patient care en_US
dc.subject health care facility en_US
dc.subject accuracy en_US
dc.subject data analysis en_US
dc.subject Asia en_US
dc.subject Terminology as Topic en_US
dc.subject Lost to Follow-Up en_US
dc.subject nomenclature en_US
dc.subject patient coding en_US
dc.subject treatment refusal en_US
dc.title Universal definition of loss to follow-up in HIV treatment programs: A statistical analysis of 111 facilities in Africa, Asia, and Latin America en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pmed.1001111
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn 1549-1676


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